[PPT] - Perioperative Diabetes Management Dr Charlotte Taylor Consultant PowerPoint Presentation

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Perioperative Diabetes Management

Dr Charlotte Taylor Consultant Anaesthetist Guy’s and St Thomas’ NHS Foundation Trust

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4.7 million people in the UK

with diabetes (9%)

1 in 6 in-patients has diabetes
13% PQIP population

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PQIP report

8.5

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PQIP report

8.5 90

Recommended upper limit of HbA1c (in %) for elective surgery

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PQIP report

8.5 90

Recommended upper limit of HbA1c (in %) for elective surgery % of patient with poor glycaemic control having elective surgery

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PQIP report

8.5 90 69

Recommended upper limit of HbA1c (in %) for elective surgery % of patient with poor glycaemic control having elective surgery

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PQIP report

8.5 90 69 20

Recommended upper limit of HbA1c (in %) for elective surgery % of patient with poor glycaemic control having elective surgery % of patients with an HbA1c recorded

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PQIP report

8.5 90 69 20

Recommended upper limit of HbA1c (in %) for elective surgery % of patient with poor glycaemic control having elective surgery % of patients with an HbA1c recorded % of patients having elective surgery with poor glycaemic control

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NCEPOD

Retrospective case note and

questionnaire review

509 patients aged 16 and over

who had type 1 or type 2 diabetes who underwent a surgical procedure

Enormous and unwarranted variation in the standard of care provided to patients with diabetes who have had surgery.

Professor Ravi Mahajan -RCOA President

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Pre-assessment

Individualised Perioperative diabetes plan
Perioperative drug changes
Fasting guidelines
Identify higher risk patients
Type 1
Poor control

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HbA1c

HbA1c % 5 5.5 6 6.5 7 7.5 8 8.5 9 9.5 10 10.5 11 11.5 12 HbA1c

mmol/mmol

31 37 42 48 53 59 64 69 72 80 89 91 97 102 108 Estimated average blood glucose 5.4 6.2 7.0 7.5 8.6 9.4 10.1 10.9 11.7 12.5 13.3 14.0 14.9 15.7 16.5

69 (8.5%) = 10.9mmol/l

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New(er) Drugs

Sodium Glucose cotransporter 2 inhibitors (GLT2i)
Gliflozins
Dipeptidyl Peptidase-4 inhibitors (DPP4i)
-gliptins
Increatin mimics
e.g. extenatide

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Analogue insulins

Ultra short acting
Fiasp (insulin aspart)
Short acting
Novorapid (insulin aspart)
Humalog (insulin lispro)
Apidra (insulin glulisine)
Long acting
Levemir (insulin detemir)
Lantus (insulin glargine)
Ultra long acting
Tresiba (insulin degludec)

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Admission

Do not change solely due to

diabetes

Avoid Carbohydrate loading

drinks in Type 1 ( and possibly insulin treated type 2)

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Avoid Variable Rate Intravenous Insulin Infusion wherever possible

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Management of Hyperglycaemia

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Management of Hypoglycaemia

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“The most conclusive way to find

ut if a patient is type 1 or type 2

is to not give them insulin. If they die they were type 1” Type 1 diabetics MUST have insulin

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New Technologies

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Key takeaways

Hospital-wide guidelines
Create an individualised plan

for your patient and communicate it

Avoid VRIII wherever possible
Make sure Type 1s receive

insulin

Monitor the patient’s blood

sugar

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Perioperative Diabetes Management Dr Charlotte Taylor Consultant - - PowerPoint PPT Presentation

Perioperative Diabetes Management

PQIP report

8.5

PQIP report

8.5 90

PQIP report

8.5 90

PQIP report

8.5 90 69

PQIP report

8.5 90 69 20

PQIP report

8.5 90 69 20

NCEPOD

Enormous and unwarranted variation in the standard of care provided to patients with diabetes who have had surgery.

Pre-assessment

HbA1c

69 (8.5%) = 10.9mmol/l

New(er) Drugs

Analogue insulins

Admission

Management of Hyperglycaemia

Management of Hypoglycaemia

“The most conclusive way to find

is to not give them insulin. If they die they were type 1” Type 1 diabetics MUST have insulin

New Technologies

Key takeaways

Further Reading